The Charing Cross International Symposium (London, UK, 14–17 April 2012) returns this year beginning another three-year cycle of themes: Controversies, Challenges and Consensus. This year’s CX promises high-profile debates between leading vascular and endovascular specialists. The programme also includes several educational opportunities, latest clinical trial data and industry-sponsored symposia.

The Vascular News Charing Cross Special Edition highlights some of the controversial topics which will take centrestage at CX34.

The future of TASC

The first Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) was published in 2000 to provide an international consensus on the diagnosis and treatment of peripheral arterial disease. With the aim of continuing to reach a readership of vascular specialists, but also physicians in primary healthcare, TASC II was published in 2007. TASC IIb was intended to be a technical update set to elaborate on the role of endovascular techniques in relation to surgery, and to include guidance on more severe lesions than those covered in TASC II, but was never published.

Many physicians are interested either in understanding why TASC IIb did not emerge after much discussion between disciplines and key societies, or listening to issues being discussed now as TASC III approaches. There are various questions to address: Will anatomical classification stay fixed and treatments then be seen to be becoming more endovascular each time? Why was TASC initiated and what is it possible to achieve with the classification? What were the aims of TASC IIb and what can be expected of TASC III?

Roger Greenhalgh, chairman, CX Programme and editor-in-chief of Vascular News said: “Some key authors of TASC III will speak and the audience will better understand the issues, have their say and even vote on issues. This will be a type of huge, open, focus group. This will be in no way official, nor threatening, but the discussion could be very helpful for TASC III authors. If anatomy is to change repeatedly to fit mode of treatment, is this a turf war in disguise?”

Aneurysm screening

The prevalence of abdominal aortic aneurysm and aneurysm rupture has decreased in recent years as a result of reduced exposure to risk factors, mainly smoking. How is this affecting aneurysm screening programmes? In a session on aortic screening, CX delegates will hear about screening experiences from the UK, Sweden and Australia and their progress.

Which TEVAR technique?

One of the most pressing topics in thoracic intervention is whether the varying types of pathologies require specific devices. “A common view is that some endovascular devices are more suitable for some pathologies than others,” Greenhalgh said.

In a debate, Peter Taylor, London, UK, will try to convince delegates that thoracic aortic pathology is key to choice of treatment. Dittmar Boeckler, Heidelberg, Germany, will attempt to convince the audience to stick to a favourite device whatever the pathology.

Faculty members will also try to answer which technique is the first choice for each pathology, including total surgical repair; total endovascular repair with branched grafts, with off-the-shelf pre-loaded fenestrated grafts and with physician-made fenestrated grafts; hybrid repair; sandwich repair; and chimney repair.

Multilayer stent

Is the multilayer stent (MARS) approach a breakthrough or not? Michel Henry, Nancy, France, Charles McCollum, Manchester, UK, and Thomas Larzon, Orebro, Sweden, will present their experiences with the device. A discussion involving the panel and delegates will take place after the talks. “We need to hear hard outcome data on this to either take up this approach, or not. We approach it with an open mind,” Greenhalgh said.

Is CCSVI an entity?

This year, a session will be dedicated to discussions around chronic cerebrospinal venous insufficiency on Tuesday 17 April. Three years ago, Paolo Zamboni sparked controversy with the presentation of results indicating that patients with multiple sclerosis benefited from endovenous treatment.

“Chronic cerebrospinal venous insufficiency is very controversial. It is not yet clear if it is an entity or not or how often internal jugular venous stenosis is found without symptoms. If it is an entity, then correction of the venous stenosis provides a possibility of improving the condition in many patients,” Greenhalgh said.

“Is chronic cerebrospinal venous insufficiency a real phenomenon? We all need to know the answer to this because if it is, patients will benefit. Doctors and patients need to know as soon as possible either to call for more of these procedures or to stop doing them altogether,” he added.

The Great Debate “CCSVI: It is an entity and a subset of multiple sclerosis” will see Zamboni and Manish Mehta speaking for the motion, and Alun Davies and Richard Nicholas arguing against the motion. After the debate, the four presentations will focus on the main questions about CCSVI, followed by a discussion with the audience.

CX34 delegates will also see several debates on other topics in vascular and endovascular intervention such as drug-elution, the CREST trial and venous disease.